The World Health Organization describes social determinants of health (including
mental health) as “the conditions in which people are born, grow, live, work and age, and
people’s access to power, money and resources”. Understanding how social determinants
impact anxiety and depression may generate recommendations in how to reduce the impact of
social determinants on mental health.
The first chapter explores the relationship between subjective social status (SSS) and
mental health disorders, specifically anxiety and depression. Subjective social status refers to
how an individual perceives their social standing (e.g., in relation to their employment and
income) relative to others. A search of existing literature for published studies in this area was
conducted. Studies were required to include participants who were 18 years or older, who had
completed a specific measure of subjective socials status called the Macarthur ladder and a
measure relating to anxiety and/or depression. In total, 65 studies were identified. Of these,
41 could be analysed quantitatively using meta-analysis. The findings suggested SSS is
weakly associated with mental health, whereby lower SSS is associated with increased
depressive and anxiety symptoms (i.e., small effect size). This did not appear to differ
according to whether different versions of the Macarthur Ladder were used for neither
anxiety nor depression. For depression, it also appeared this did not differ according to where
the study was conducted or how old participants were. However, when considering the results
of all 65 studies (descriptively, not quantitatively), there was some evidence to suggest the
relationship between SSS and mental health may differ when looking at subgroups of
individuals, according to how identity characteristics interact (e.g., race/age). Additionally,
certain social factors and thinking styles appear to play an important role in influencing the
relationship between SSS and mental health. However, further research in these areas is
needed to quantitively summarise whether/how different variables impact the relationship
between SSS and mental health.
The second chapter aimed to characterise the relationship between various social
determinants of health with anxiety and depression, in a sample of individuals who closely
represent the English population. A network model approach was used, which is a graphical
and statistical way of exploring which factors are connected and how strongly. Two models
were created, one looking at the relationship between social determinants and anxiety and
another with depression. Overall, each model explained a noticeable amount of variance in
anxiety and depressive symptoms. The determinants having the greatest direct impact on both
anxiety and depression related to how lonely someone is, how many positive childhood
experiences they have experienced, whether they are in receipt of benefits, and how old they
are. Other determinants relating to socioeconomic status appeared to have an indirect effect
on anxiety and depression. Overall, the study highlights that social determinants contribute to
population-level mental health, and interventions which address relational and socioeconomic
factors will likely reduce anxiety and depressive symptoms in adults in England.
